Evidence desk · Personal synthesis
The protocol
The synthesis
Six source cards, collapsed into one protocol. For each lever, the best-supported recommendation — credited to where it actually comes from, and filtered through your Life OS (the cut on Zepbound, ApoB 89, HOMA-IR 3.65, the face-protection floor). Age-old advice is credited to Grandma's wisdom; specific calls go to the person who earned them.
The headline, in one breath: the free fundamentals carry most of the benefit, a single specialist (mostly Attia) tunes the ~20% that matters for your risk, a few things are optional, and a long list of hyped, expensive, or unproven interventions are safe to ignore. Do the boring part first; everything below is sorted by how much it actually moves the needle.
What's inside
How the payoff stacks up
The single most useful idea on the whole desk: leverage is wildly uneven. The free foundations do most of the work; the precision layer is a cheap, targeted add-on for your specific risk; the rest is optional or noise. Sorted by real-world payoff, it looks like this — and notice the hype is the thinnest bar.
The foundation
Non-negotiable, free, and the highest-evidence part of everything here. Mostly Grandma — every guru on the desk is, at heart, restating these. Do them first; you mostly already do.
| Lever | Your call | From |
|---|---|---|
| Diet base | Whole, minimally-processed food, protein-forward, mostly plants; cut added sugar and ultra-processed food. (Your HOMA-IR makes the sugar discipline the single highest-value food habit.) | Grandma |
| Movement | Daily Zone 2 (walking counts) + resistance training 2–4×/week + the occasional all-out sprint. | Grandma · Attia · Sisson |
| Sleep | Enough, and on a regular schedule — same hours daily. Cheapest high-leverage win if it isn't already locked in. | Grandma · Johnson |
| Smoking & alcohol | Don't smoke; keep alcohol low (less is better). The biggest free levers — you're already past them. | Grandma |
| Social connection | Deliberate time with people you love — treat it like a health metric, not an afterthought. The lever the whole desk under-weights. | Grandma |
| Stress & daylight | Manage stress; get daylight for circadian rhythm — but no deliberate burning (see the skip list, given your tretinoin). | Grandma |
Precision for your risk
The ~20% the fundamentals can't see — tuned to your panel. This is almost entirely Attia's contribution, because your roadmap already is his framework. Confirm anything touching meds with your prescriber.
| Lever | Your call | From |
|---|---|---|
| ApoB | Treat ApoB (89, "watch") as the target — not body weight — and drive it toward <70. South-Asian + insulin-resistant is exactly the higher-risk profile where lowering pays; discuss a statin ± ezetimibe with your doctor. | Attia |
| Lp(a) | Measured once (15 nmol/L, optimal) — done. No further action. | Attia |
| Insulin resistance | Reverse it (HOMA-IR 3.65, TCF7L2): the Zepbound cut, fasted Zone 2, fiber, protein, muscle. Your whole plan already is the right response — keep going. | Attia |
| Protein + muscle on a GLP-1 | Hold ~170 g protein/day (~2 g/kg) plus progressive resistance training to defend lean mass through the cut — the GLP-1's one real risk. | Attia · Sisson |
| Body composition | Track visceral fat on DEXA (VAT 65.6 → <52); stop the cut at 14–15% to protect face and hormones — don't chase lower. | Attia · your filter |
| Fiber | Add viscous fiber (psyllium) for ApoB/LDL, glycemic load, and GLP-1 regularity. Cheap, multi-purpose. | Grandma · the desk |
| Creatine | 5 g/day — the highest-confidence supplement for strength and lean mass; especially worth it on a cut. | broad consensus |
| Vitamin D | You're at 59 ng/mL — maintain, don't escalate. VDR reduced-function makes a sensible target reasonable, but dose to the number, not above it. | Patrick / Johnson, dialed down |
| Omega-3 | Index already optimal — maintain, don't chase a higher number (see the fish-oil card). | Patrick · Attia |
The supplement stack
Everything above blends behaviours, screening, and pills. Here's just the supplements, pulled into a stack you can actually run — what's worth it for anyone, what's worth it for you, and how it travels across your phases. Every row links to its full verdict on the evidence desk.
| Supplement | For most? | Only if… |
|---|---|---|
| Creatine 3–5 g | Yes | The one near-universal pick — strength, lean mass, maybe cognition. Cheap, safe, well-replicated. |
| Protein powder | If short | …you can't hit a daily protein target from food. A convenience tool, not magic. |
| Vitamin D | If low | …a blood test shows a real shortfall. Dose to the number, don't megadose. |
| Omega-3 | If no fish | …you rarely eat oily fish. Food first; the pill fills the gap. |
| Psyllium fibre | If low-fibre | …your diet is short on fibre. Cheap and multi-benefit. |
| Magnesium (glycinate) | If low intake | …repletion only; effects are modest. |
| Multivitamin & most others | No | Insurance you rarely need — test and target a specific gap instead. |
The rule underneath the table: food, sleep, and training first. A supplement earns a slot only by clearing the evidence bar (creatine) or filling a measured gap. Most people who eat well need little here.
Your version, re-derived against your numbers (170 g protein, ApoB 89, HOMA-IR 3.65, vitamin D 59, omega-3 already optimal, Phase 1 cut on Zepbound) and sorted into four tiers:
| Tier | Supplement | Your call |
|---|---|---|
| Core | Creatine 5 g | Strongest lever — defends lean mass + strength on the cut. Never cycle off. |
| Whey / protein | The tool to hit your 170 g floor against suppressed appetite. The macro the GLP-1 fights you on. | |
| Psyllium | One scoop, three of your levers at once — ApoB/LDL, glycaemic load, GLP-1 regularity. | |
| Vitamin D3 | Maintain ~59 — dose to the number, don't escalate. K2 optional. | |
| Omega-3 | Maintain — you're already optimal. Step the double dose down to single and retest. | |
| Situational | Magnesium glycinate | Optional repletion; mild rationale on a cut (less food). Add only if sleep or intake warrants. |
| L-theanine | As-needed calm/focus — with coffee, or to soften the Vyvanse edge. Low stakes. | |
| Trim first | Collagen ~11 g | Weak, funding-skewed skin lever — a cheap rider, the first scoop to drop. |
| HMB 3 g | Redundant once protein + training + creatine are running. The other scoop to drop. | |
| Skip | Multivitamin · Mg L-threonate · GlyNAC · peptides | No clear case for you — plus the testosterone boosters and alpha-GPC in the skip list below. |
The refinement — what to actually change
You're already running the core well; this is about shedding the dead weight, not adding more. Three concrete moves:
- Step omega-3 down from the double dose to a single, then re-test the panel in 3–4 months — you're optimal, and higher isn't shown to buy anything (fish-oil card).
- Drop collagen and HMB — the two lowest-evidence riders in the shake. Keep them only if you like the ritual, but don't credit them; the lean-mass work is protein + training + creatine.
- Magnesium glycinate only if sleep or mineral intake is genuinely off — not by default.
Net: a leaner shake — whey + creatine — with psyllium, vitamin D, and omega-3 around it. Five core items, doing real work, each tied to a number you track.
| Supplement | Cut (now) | Build | Maintain |
|---|---|---|---|
| Creatine 5 g | keep | keep | keep |
| Whey / protein | ~2–2.4 g/kg | ~1.6–2 g/kg | ~1.2–1.6 g/kg |
| Psyllium | keep | keep | keep |
| Vitamin D3 | maintain ~59 | maintain | maintain |
| Omega-3 (single) | maintain | maintain | maintain |
| Magnesium glycinate | optional | optional | optional |
| Collagen | optional | drop | drop |
| HMB | optional | drop | drop |
The honest summary: only protein amount really moves with the phase. The core supplements are phase-invariant keepers, and the two riders are the only things to actively shed once the cut ends.
Worth considering
Real but small — preference, not needle-movers. Fine to do if you enjoy them; nothing here earns a place in the core plan.
| Lever | Your call | From |
|---|---|---|
| Sauna | Enjoy it as recovery if you like the heat — but don't bank on the Finnish-cohort longevity numbers. | Patrick |
| Time-restricted eating | Optional. On Zepbound, appetite suppression already does the calorie work; a tight window adds little. | Patrick · Sisson · Johnson |
| Cold exposure | Fine "for the mind"; minimal hard metabolic benefit. Both Sisson and Johnson are honest about this. | Sisson · Johnson |
| Foot / minimalist-shoe work | Low stakes. Foot-strengthening is real; transition slowly if curious. | Sisson |
| Disciplined measurement | Track the few decision-relevant markers (ApoB, HOMA-IR, VAT) — the good half of Johnson's ethos. Not everything. | Johnson |
Stay away from the hype
The point of doing all this homework: a clear, sourced list of what to ignore — unproven, ineffective, inefficient, or actively wrong for you. Each is credited to whoever pushes it, so you know the tell when you hear it again.
| Skip this | Why | Pushed by |
|---|---|---|
| Rapamycin for longevity | Animal-data bet with real side effects; both Attia and Johnson tried it and backed off. | Attia · Johnson |
| Young-plasma / "blood boy" exchanges | No human benefit — Johnson ran it on himself and quit. | Johnson |
| Offshore gene therapy (follistatin) | Unregulated, irreversible, animal-only data. A flat no. | Johnson |
| Big "longevity" stacks — NMN/NR, spermidine, CaAKG, resveratrol | No human hard-outcome data; Attia calls resveratrol "nonsense." | Johnson · marketing |
| Chasing an epigenetic-clock "age-reversal" score | Noisy surrogate; "31 years younger" is a category error. Track ApoB/HOMA-IR/VAT instead. | Johnson |
| Whole-body MRI & multi-cancer blood tests | Overdiagnosis-prone; the Galleri RCT just failed. Not for you at 41 (a colonoscopy by ~45 is the reasonable piece). | Attia |
| "Saturated fat is harmless — eat butter/coconut freely" | Settled to raise ApoB; wrong trade for your 89 + South-Asian risk. The Primal idea most worth un-learning. | Sisson |
| "Seed oils are toxic" / avocado-oil necessity | Linoleic acid is neutral-to-protective; don't fear-swap to butter (which raises your ApoB). The alarm sells his oil. | Sisson |
| Eliminate grains & legumes | Net-protective, high-fiber, high-satiety — keep them, especially on a cut. | Sisson |
| Keto for everyone / "effortless" / endurance boost | Ties other diets long-term and can spike LDL; you don't need it — Zepbound is doing the calorie work. | Sisson · Johnson-adjacent |
| Testosterone boosters (tongkat, fadogia, zinc-boron) | Your T ~597 is fine, and fadogia has zero human safety data. | Huberman |
| Alpha-GPC for focus | A TMAO/stroke signal lands badly against your ApoB and CV risk. | Huberman |
| Deliberate sun for vitamin D | You're already replete and on tretinoin (photosensitizing) — a bad trade for you specifically. Ignore "sun prevents skin cancer." | Sisson · Patrick |
| Collagen as muscle protein / "fourth macronutrient" | A poor muscle protein; the skin evidence is funding-skewed (see the collagen card). | Sisson · Patrick |
| Peptides (BPC-157 & friends) | Anecdote plus preclinical data; never DIY unapproved injectables. Your own rule, and the right one. | Reddit hype |
How to run it
Foundations are non-negotiable and free — do them first and always. Tune the precision layer with your prescriber against your actual panel (ApoB, HOMA-IR, VAT), not against a podcast. Treat "worth considering" as preference, and the skip list as settled-ignore until something genuinely changes. New claim shows up? Run it through your operating filters and is it strong enough to act? before it earns a slot. The meta-rule from the whole desk: when Grandma and a specialist agree, that's the signal — and when an expensive protocol contradicts her, that's the claim to distrust hardest.
The sources, one line each
- Grandma's wisdom — the free foundation that carries most of the benefit; do it first.
- Peter Attia — the precision layer for your cardiometabolic risk (ApoB, insulin, muscle, VO₂max). Your closest match; question only his aggressive screening.
- Rhonda Patrick — maintain-don't-escalate on omega-3 and vitamin D; sauna as a nicety, not a number.
- Mark Sisson — keep the fitness fundamentals; discard the ancestral lipid claims (sat fat, seed oils, no grains).
- Andrew Huberman — the free behavioral levers, yes; the supplement stack, no.
- Bryan Johnson — copy the measurement discipline and the habit of dropping what doesn't work; skip the scoreboard, the stack, and the exotic bets.
The machinery behind this
This page is the output; the engine is your operating filters and the research-methods toolkit — the evidence ladder, surrogate vs hard outcomes, the funding filter, and is it strong enough to act? Re-derive any row yourself.
Built from the six source cards on this desk — Grandma's wisdom, Attia, Patrick, Sisson, Huberman, Bryan Johnson — each of which carries the primary-source citations for its claims. A personal synthesis, not medical advice; confirm anything touching your medications with your prescriber.